FluSurv-Net Influenza Hospitalization Surveillance Project Vaccination Phone Script and Consent Form (English/Spanish)

[NCEZID] Emerging Infections Program

OMB: 0920-0978

IC ID: 207653

Information Collection (IC) Details

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FluSurv-Net Influenza Hospitalization Surveillance Project Vaccination Phone Script and Consent Form (English/Spanish) 0920-0978-24BX
 
No Modified
 
Voluntary
 
42 CFR 301 Public Health Service Act

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0978-24BX FluSurv NET Vaccination Phone Script Att12- FluSurvNet_PhoneScript_English.pdf NA Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

14 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 224 0 -3,106 0 0 3,330
Annual IC Time Burden (Hours) 37 0 -241 0 0 278
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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